About the position
At Lurie Children's we understand that caring for kids takes more than medicine. From diagnosis through treatment, it requires compassion and understanding that kids do best when they get to be kids. With a team of world-renowned pediatric experts and kid-friendly care, there's a reason we're ranked the #1 children's hospital in Illinois. The Senior Managed Care Liaison is responsible for the day-to-day operations of CIN value-based contracts and developing and maintaining strong relationships with the CIN provider network. This role collaborates with the CIN leadership team, payers, Lurie Children's administrators and subspecialists, and community physicians to achieve departmental and customer service goals. Reporting to the Manager of Network Operations, this role is essential to ensuring compliance with contract requirements, supporting CIN network operations, and leading business development.
Responsibilities
- Serve as the primary contact for CIN providers, acting as a liaison between physicians and payers for investigation and resolution of billing issues, network management, and tracking/distribution of fee schedules.
- Assist in value-based contract negotiations through financial analysis and contracted rate reviews; facilitate discussions around analysis and implementation of contracts based on existing in-network agreements; proactively identify out-of-network opportunities.
- Conduct ad hoc analyses as requested by senior leadership related to contract financial data, market assessments, and demographic trends.
- Manage the CIN network and payer rosters including auditing enrollment files and provider attribution, and reconciling monthly contract revenue in accordance with CIN contracts.
- Develop and consistently update tools for marketing the value of CIN participation and communication with CIN physician members.
- Cultivate effective working relationships with cross-functional departments such as Finance, Legal, Physician Services, Medical Staff Office, Revenue Cycle and Finance.
- Onboard new practices, update and maintain the CIN provider database, ensuring completion of required documentation for new practices, and maintain the integrity of the rosters for payer contracts.
- Collaborate with provider practices and credentialing organizations to ensure that providers are credentialed in accordance with policies and procedures.
Requirements
- Bachelor's degree required, master's degree preferred.
- Minimum of 4 years' experience in health care environment, with experience in value-based care or managed care.
- Understanding of health insurance operations highly preferred.
- Excellent closed-loop communication with the ability to consistently maintain efficient follow up with necessary stakeholders regarding ongoing and outstanding subjects.
- Strong interpersonal skills with the ability to effectively collaborate with physicians, administrators, and external stakeholders.
- Demonstrated ability to successfully handle multiple projects simultaneously to meet strict deadlines.
- Demonstrated competency and accuracy working with spreadsheets, database, and mainframe applications.
- Ability to take initiative by identifying problems, conceptualizing solutions, and implementing change at all levels throughout the organization.
- Ability to work independently as well as collaboratively with people from all levels of the organization.
- Proficient in the use of MS Office Applications with emphasis on Excel and spreadsheet management.
- Ability to work remotely with minimum oversight.
Benefits
- Medical, dental and vision insurance
- Employer paid group term life and disability
- Employer contribution toward Health Savings Account
- Flexible Spending Accounts
- Paid Time Off (PTO), Paid Holidays and Paid Parental Leave
- 403(b) with a 5% employer match
- Various voluntary benefits including Supplemental Life, AD&D and Disability, Critical Illness, Accident and Hospital Indemnity coverage
- Tuition assistance
- Student loan servicing and support
- Adoption benefits
- Backup Childcare and Eldercare
- Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members
- Discount on services at Lurie Children's facilities
- Discount purchasing program
